Spinal metastasis is becoming more common with aging population and is no more treated by one person. The workup and staging has changed dramatically with different validated scoring systems, which can give us guidelines on treating our patients. This review paper gives a comprehensive tour of different stages of the management. The spinal metastatic disease requires, a multimodality treatment with a humane approach, and all the possible information should be gathered, and the available tools and scores shod be applied to guide decision making, and treatment.